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Second opinion and medical collaboration repair heart defect

Consultation at Loyola help save pilot's life

Bill Robel knew he had a problem with a heart valve since grade school, but other than a slight murmur, he never had any symptoms. Then approximately five years ago, not long after he turned 50, Bill’s doctor said the valve might not be working well due to calcification. He also started to feel tired when shoveling snow.

“I’d have to stop periodically, but I just thought I was getting older and getting out of shape,” Bill said.

Bill is a corporate pilot, and in late 2010, the Federal Aviation Administration required him to have a physical exam to ensure that he could still operate a plane safely. The results kept him from flying. A cardiologist thought he needed angioplasty to clear a blocked coronary artery and a stent to keep it open.

Bill wanted a second opinion, so his wife, Missy, did extensive research. They learned that Loyola’s Center for Heart & Vascular Medicine offers state-of-the-art therapies. For the seventh year in a row, U.S. News and World Report® magazine has named Loyola University Hospital as one of the top 50 hospitals nationwide for heart care and heart surgery.

Bill and Missy decided to travel approximately 45 miles from their home in Ringwood, Ill., to Loyola’s Maywood campus, where they met Lowell Steen, Jr., MD, associate professor, cardiology, Loyola University Chicago Stritch School of Medicine (Stritch).

“An echocardiogram demonstrated significant stenosis (narrowing) of Bill’s aortic valve, and with the onset of his experiencing shortness of breath, we took him into the catheterization lab for more precise imaging of his heart,” Dr. Steen explained. “We do this routinely for men over 40 to make sure that they do not also have coronary artery disease.”

In addition to an angiogram, Dr. Steen performed a complex and difficult procedure to measure the pressure within his heart chambers. Loyola cardiologists are especially proficient in “crossing the valve” with a wire that captures these pressures.

“We try to give the surgeon as much data and information as possible,” said Dr. Steen, “and knowing the intra-chamber pressures helps identify an individual’s risk associated with the operation. It’s almost always the best approach, so we do it for nearly every valve patient.”

Dr. Steen explained to Missy and Bill that while his arteries looked fine, he needed a surgeon to replace his aortic valve. “Valve surgeries are complex, so you don’t want someone who only does two or three a year,” Dr. Steen said. “You want someone who is very skillful and comfortable implanting all types of valves, whether mechanical or derived from animal tissue.”

Loyola’s interventional cardiologists and cardiac surgeons enjoy very close and collaborative relationships. With shared office space, it is effortless for them to meet simultaneously with patients, review diagnostic films together and ultimately agree upon a recommendation for each patient’s treatment. This multidisciplinary partnership enables patients and family members to easily gather the information they need to make their decisions.

“Bill and Missy came into my office very knowledgeable about valve surgery,” remembered Jeffrey Schwartz, MD, associate professor, thoracic & cardiovascular surgery, Stritch. “It’s refreshing to have patients take the time to educate themselves. The tech-savvy patient is more common, and I think that’s great.”

“Dr. Steen and I discuss treatment options with patients and family members, as does my nurse. We want to give them time to think about their choices and make it as painless and pleasant as possible to decide what’s best for the patient’s lifestyle.”

“I’m a nurse and I did a lot of research on the web,” Missy said. “I wanted the best for Bill, so we came to Loyola. They explained everything to us in layman’s terms. Everyone was kind, courteous and quick. You don’t see that human connection very often elsewhere. Everyone was very supportive of Bill and me.”

Bill and Missy agreed with their medical team that a tissue valve would be his best option, in large part because it would not require Bill to take blood-thinning medications that mechanical valve patients must take to prevent blood clots.

“They may not last as long as mechanical valves, but tissue valves give patients the flexibility and freedom of not being on

blood thinners for the next 15 to 20 years,” Dr. Schwartz said. “Also, I explained that by the time Bill’s valve needs replacing, technology will have advanced so that he probably won’t need another open-heart surgery. We give patients information not only about this operation, but also what treatments might be available in the future.” (See story at the bottom of this page.)

Bill’s surgery was in February, and today he says he is healing well and doing great. He remembers his four-day recovery in the hospital as surprisingly pleasant. “I had a beautiful room with a view of the Chicago skyline. Missy stayed with me the entire time, sleeping on a couch in the room. She was very happy with the setup, and we both thought the nurses were terrific.”

“It was very comforting to be there to help him,” Missy said. “Everyone was supportive to me and Bill. I felt such a human connection at Loyola.”Bill has joined a health club and intends to lose 20 pounds by the end of the summer. He also wants to reach one more goal in September. “I hope to return to my job as a pilot and start flying again!”

Hybrid Operating Room Serves Two Specialties

Loyola is participating in a research study that soon might provide a less-invasive option for patients like Bill Robel (see story on left). In this clinical trial, interventional cardiologists and cardiovascular surgeons work together to insert a catheter into an artery in a patient’s groin to transport the experimental valve to a patient’s heart, then implant the valve into its proper position.

Loyola physicians use a new state-of-the-art hybrid operating room for this exciting trial, which integrates the latest imaging technologies for better valve placement and positioning.

“Sometimes you plan to repair an aneurysm or open a blocked artery with a stent, only to learn that open surgery is required,” explained Pegge Halandras, MD, assistant professor, vascular surgery & endovascular therapy, Stritch School of Medicine. “Other times you know that a combination of percutaneous (through the skin) and surgical procedures is best. Our new leading-edge technology enables us to provide both treatments in the same room, offering optimal imaging with less radiation exposure for percutaneous procedures and the sterility and high-intensity lighting required by surgeons for open procedures.”